tag:blogger.com,1999:blog-11034229.post113525270144176647..comments2015-03-01T03:55:40.082-08:00Comments on retired doc's thoughts: DCCT/EDIC : Glycemic control may decrease cardiovascular riskjames gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-11034229.post-1135368222331901442005-12-23T12:03:00.000-08:002005-12-23T12:03:00.000-08:00Your points are well taken.There appeared to be no...Your points are well taken.There appeared to be no difference in the hemoglobin a1c values in the 11 year follow-up between the two groups suggesting any serious hypoglycemic episodes should have been about the same in each group but the absence of data to that point is a weakness of the study. There were significantly more hypoglycemic episodes in the intensive treatment group during the 6.5 years of the actual trial and part of the cost of decrease in microvascular complications was more hypoglycemia.I agree we should know about total mortality.james gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1135365130364807482005-12-23T11:12:00.000-08:002005-12-23T11:12:00.000-08:00[As I posted on MedRants....]As best as I can tell...[As I posted on MedRants....]<BR/>As best as I can tell, the article includes no data about survival rates in each group, and no data about possible adverse effects of tight control (e.g., hypoglycemic events and their consequences) at all.<BR/>If one assumes that the decreasing numbers in the groups from the start of the trial to year 11 found in Table 1 represent losses due to mortality, there appears to be no survival advantage from tight control. Given that there were fewer cardiac events in the tight control group, lack of survival advantage may be due to fatal hypoglycemic events in that group.<BR/>As I recall, the original DCCT trial showed a marked increase in hypoglycemic events in the tight control group, and thus it was not clear that the trade-off of less microvascular events due to tight control for more hypoglycemic events was favorable to patients.<BR/>In the absence of data about total mortality or about hypoglycemic events, this study does not convincingly argue for tight control as the best alternative for patients.Roy M. Poses MDhttp://www.blogger.com/profile/00497209843184497847noreply@blogger.com